Remotely piloted aircraft (RPA; also called drones) constitute a new dimension in aviation. In the past, the military used RPAs extensively in the conflicts in Iraq and Afghanistan. Meanwhile, they are employed worldwide, which illustrates the new way of future complementary military warfare. It is well known that military personnel develops mental health disorders (MHD) during their military services or after deployments, including military pilots or fighting personnel (15.9 per 1,000 person-years). Despite the assumption that operators of drones compared to pilots are not vulnerable to MHD, because they are not physically involved and far away from combat operations and the battlefield, it becomes apparent that there is evidence that they are affected in the same way. During the last years, typical symptoms of PTSD occurred in such individuals and resulted in a severe disturbance of health (25.0 per 1,000 person-years). Currently, to our best knowledge, only in the U.S. Air Force (USAF) RPA operators participate directly in the act of war also using destructive weapons. Especially in this population, increasing and high levels of psychological stress, fatigue, and rates of MH diagnoses were found, without significant difference in the rates of post-traumatic stress disorder, depressive disorders, and anxiety disorders between RPA operators and traditional pilots. The German Air Force has been using drones up to now exclusively for reconnaissance. According to empiric observation, the development of MHD among German RPAs operators was not observed, but it has to be assumed that we will also find these illnesses if we proceed with this technology. Hence, military policymakers and clinicians should be highly sensitive to the fact that RPA operators also have a high probability of developing mental health disorders, particularly when using remotely piloted aircraft as weapons.